LIFE REVIVAL LLC NPI 1023701067

NPI Information

NPI: 1023701067
Provider Name: LIFE REVIVAL LLC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
:
Address: 6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149
Phone: (267) 577-7747

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NPI Details

LIFE REVIVAL LLC is a community behavioral health in Philadelphia, PA. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. LIFE REVIVAL LLC NPI is 1023701067. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149-943
Phone: (267) 577-7747

The provider's authorized official is Daniel Lee .
The authorized official title is Director and has the following contact phone number (267) 259-4558.

The enumeration date for this NPI number is 5/26/2023 and was last updated on 2/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YM0800X	Counselor	Mental Health	No
2	103TC1900X	Psychologist	Counseling	No
3	103TF0000X	Psychologist	Family	No
4	103TP0814X	Psychologist	Psychoanalysis	No
5	103TP2701X	Psychologist	Group Psychotherapy	No
6	1041C0700X	Social Worker	Clinical	No
7	2084P0800X	Psychiatry & Neurology	Psychiatry	No
8	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	No
9	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	No
10	251B00000X	Case Management		No
11	251S00000X	Community/Behavioral Health		Yes
12	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
13	261QM0850X	Clinic/Center	Adult Mental Health	No
14	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
15	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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